Heart period variability in seizure-related sinus arrest

Analysis of heart period variability (HPV) is a valuable tool for the evaluation of autonomic influences over the cardiac cycle in patients at risk of sudden death. Using both time and frequency domain techniques, we analyzed the variation in heart period for five episodes from a 3-month-old infant who had recurrent periods of asystole related to generalized tonic-clonic seizures (GTCS). The frequency domain analysis consistently showed increased power in the low-(0.0–0.04 Hz), middle-(0.04–0.12 Hz), and high-(0.2–0.4 Hz) frequency bands during the ictus as compared with preictal states, suggesting an increase in both parasympathetic and sympathetic influences on the heart period during these seizures. Similar power spectra changes in other patients with GTCS are associated with tachycardia. These findings are in contrast to HPV patterns detected in patients with cardiac disease at risk of sudden death. This case suggests that sinus arrest produced by seizures may be related to more complex autonomic influences on heart period than are postulated with cardiogenic sudden unexpected death.

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